Pentoxifylline in Perforated Peritonitis: Results of a Randomised, Placebo Controlled Trial

Objectives : To evaluate the role of pentoxifylline as an adjuvant to operation and routine antibiotic treatment for perforated peritonitis. Design : Randomised controlled clinical trial. Settings: University hospital, India. Subjects : 36 patients with clinically diagnosed and radiologically confirmed perforated peritonitis. 22 (61%) had typhoid enteric perforations, 11 (31%) had duodenal ulcer perforations while 3 (8%) had perforated gastric ulcers. Intervention : Laparotomy with closure of perforation and lavage together with routine antibiotic treatment (ciprofloxacin and metronidazole), and random allocation to pentoxifylline 200 mg/day for 3 days in 500 ml of saline over 3-4 hours or saline alone ( n = 18 in each group). Main outcome measures : Hospital stay, APACHE II scores, and the condition of the wound during the postoperative period. Results : The baseline characteristics of the two groups were essentially similar. However, their preoperative APACHE II scores differed significantly (mean (SD) 12 (3) in the pentoxifylline group compared with 10 (2) in the saline group; p < 0.01). The outcome was better in the pentoxifylline group in terms of significantly reduced hospital stay (median 8, range 6-17, compared with 11, 7-27, p = 0.02) improved postoperative APACHE II scores (mean (SD) 8 (2) compared with 9 (2), p = 0.02), and reduced incidence of wound infection (6/18 compared with 12/18, p = 0.02). Conclusion : The addition of pentoxifylline to our standard management protocol for patients with perforated peritonitis helped to improve their outcome significantly compared with a placebo-treated group.